Provider Demographics
NPI:1508034927
Name:AGOH, EMMANUEL ULONNAYA (MD)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:ULONNAYA
Last Name:AGOH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EMMANUEL
Other - Middle Name:ULONNAYA
Other - Last Name:AGOH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8109 CULLEN BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77051-2064
Mailing Address - Country:US
Mailing Address - Phone:713-734-1697
Mailing Address - Fax:713-733-9316
Practice Address - Street 1:8610 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033-2308
Practice Address - Country:US
Practice Address - Phone:713-734-1697
Practice Address - Fax:713-733-9316
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7668207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX309335301Medicaid
TX309337904Medicaid